Individual
DALE A. FAVIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1532 SE 52ND AVE, PORTLAND, OR 97215-3316
(503) 239-5241
Mailing address
1532 SE 52ND AVE, PORTLAND, OR 97215-3316
(503) 239-5241
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
14610
OR
Other
Enumeration date
12/04/2009
Last updated
12/04/2009
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